Biofeedback Therapy / Self-Regulation Training
Self-awareness and better health can be achieved through the use of a technology called biofeedback. Bio (biology), and feedback (information received through a self-monitoring process), allows us to learn about and observe a variety of our physiological processes occurring internally within the mind and body. Through awareness training, we may alter such physiological processes, and learn and condition a more relaxed and healthy response to stress and the challenges of daily living. Along with psychotherapy, the objective would be to reduce symptoms that manifest as a result of stress, including psychosomatic illnesses and anxiety disorders, and help restore mental balance and physiological homeostasis leading to better mental and physical health. The ultimate objective is to feel better on a daily basis.
Through awareness and training, we can learn to recondition over-learned, self-limiting habitual and patterns to gain new skills and healthy habits that improve health and wellness. Maladaptive patterns include: faulty breathing, anxiety, obsessive thinking, worried or irrational thinking, dysfunctional beliefs, fear and guilt, rage, poor posture, and type A behavior. Such patterns and can lead to chronic conditions of tensed muscles, constricted blood circulation, sweaty palms, increased blood pressure and heart rate, a host of psychosomatic disorders, and basic idiosyncratic responses of the body toward perceived stressful events.
The success of biofeedback as an instrument for improving health is based on the principles of the traditional learning theory. Learning, through the direct result of experience, can lead to changes in behavior. If the changes in behavior are reinforced, the old behavior can become re-conditioned and shaped to conform to new and desirable changes in behavior. What scientists have recently discovered (although ancient cultures including martial artists and yogis have known for centuries) is that many internal physiological processes can be altered through self-regulation, self-awareness, and through the use of state-of-the-art technology such as biofeedback. Biofeedback is both visual and auditory, and includes coaching and interaction with a therapist.
Extensive research on biofeedback therapy lends supports to its clinical efficacy for treating a variety of disorders, including: anxiety disorders, test or performance anxiety, fecal and urinary incontinence, gastric distress, chronic pain disorders, phobias, insomnia, posttraumatic stress disorder, panic attacks, anxiety disorders, headaches (migraine and tension), essential hypertension, Raynaud’s Disease, asthma, arthritic pain, diabetes mellitus, hypoglycemia, sport’s injuries, constipation, muscle spasms, bruxism (teeth grinding), temporomandibular joint disorder (TMJ), neuromuscular dysfunction, nocturnal enuresis, among other stress-related disorders.
Biofeedback utilizes electronic instruments through the computer. The sensors placed on the client accurately measure a variety of physiological responses, processes the information, and feeds-back data to a client regarding normal and abnormal neuromuscular and autonomic physiological activity, through auditory and/or visual feedback signals. The objective is to help clients develop greater self-awareness and voluntary control over various physiological processes that are otherwise outside of conscious awareness and/or under less voluntary control in daily life. Through practice, a client can achieve greater bodily control through regulating the biofeedback signals, and then generalize the skills for a desired response without the machine by using their own internal cues as feedback.
Biofeedback offers seven different treatment modalities which will be explained in further sections, including EMG, GSR, skin temperature, heart rate, respiratory, blood pressure, and EEG. In addition, many of the therapeutic strategies that are utilized to support healing include: cognitive therapy, hypnosis, autogenics, progressive muscle relaxation, among other methods.
Treatment begins with a clinical interview and a general stress test, with the first six modalities mentioned above being measured. The clinician uses this procedure to gain a holistic understanding of a client’s dominant stress patterns, and create a treatment plan.
In addition to gaining insight into issues causing stress, we may increase awareness of old, conditioned, and maladaptive thought patterns and behaviors, which often can be unlearned, and retrained to conform toward more desirable responses. However, this type of therapy requires absolute motivation and commitment from a client. Just as it took many years, or in many cases a lifetime to condition the problem, it takes diligence and energy to re-condition and reshape new patterns of thinking and behavior, and to heal stress-related illness.
As a participant in biofeedback training, you will learn about the human body as it pertains to your unique challenges, and you will be explained what is occurring with regard to the signals on the computer in relation to physiology and symptoms. As a coach, your therapist will provide training and suggestions to help you to achieve the desired change and positive feedback, and reinforce (feed-forward) any strategies you discover that are successful in helping you relax your autonomic response system, and reduce anxiety. Through continuous verbal feedback about your own mental thought patterns and unique emotional processes, as well as through visual and auditory feedback from the computer, you may gain a new self-awareness for self-regulation of the very mental and physical habits which trigger or contribute to unpleasant stress-related symptoms.
For example, among clients who experience chronic headaches , EMG biofeedback may help them learn to alter muscle tension in certain areas of the neck and forehead that have been demonstrated to relieve tension-type headaches. For individuals with chronic anxiety, changes in thinking patterns and maladaptive beliefs may result in a reduction of the very behaviors that support an anxious style. This type of learning can lead to greater confidence and an improvement in lifestyle. The client basically learns self-mastery by achieving greater control over thoughts, beliefs, physiological responses and behavior. Through self-insight and learning, a client may gain a new perspective of the problem, and execute new strategies for positive, lasting change.
We will now discuss six physiological processes commonly associated with hyperarousal of the body’s stress- response system include: skeletal muscle tension, blood vessel vasoconstriction (smooth muscle activity), electrodermal activity (sweaty palms), respiration (breathing patterns), blood pressure and heart rate. These physiological functions are intimately involved in the emotions of anger, fear, excitement, and arousal. The overall goal of biofeedback is to recover the body’s normal “idling speed,” homeostasis, balance, and equilibrium, leading to feelings of peace and tranquility.
EMG biofeedback is used to monitor muscle contraction. Essentially, muscle usage results in electrical activity associated with the contractions of muscles. When a muscle contracts, it shortens its bundles of muscle fibers in attempt to pull its two anchor points together. Muscle fibers become stimulated into action by “motor units,” electrical signals in the nervous system. The amount of electrical stimulation corresponds to the sum of activity in the muscle fibers. Electrical activity in the muscles can be sensed with sensor electrodes. Biofeedback can be useful for treating a variety of disorders resulting from chronic muscle tension. Chronic muscle tension can result from poor posture, stress, trauma, or certain patterns of thinking. Such tension can lead to increased firing of the muscles, often resulting in chronic muscle activity and tension. Think of the end of the day tension headache from being “locked” in a traffic jam, or “bracing for a stressful event, each having clenched fists and tightened muscles. Through EMG awareness, a client can observe this conditioned response and learn how to release the tendency to “tense up” under stress.
Another way to measure physiological response to anxious thoughts and emotions is through observing hand and feet temperature. Peripheral temperature biofeedback monitors subtle changes in skin temperature, which result from constricting or dilating smooth muscles surrounding the diameter of peripheral blood vessels to the extremities. This procedure monitors temperature changes that result from the warm blood being passed through the blood vessels to the hands and feet. In other words, “warm hands, warm heart” is really, “warm hands, relaxed body.” Cold hands describe the physiological state of constricted blood vessels resulting from the emotions of fear, anxiety, or general feelings of uptightness. Migraine headaches often co-occur with cold hands. Cold extremities can also have other causes including poor circulation (e.g., Reynaud’s disease, low thyroid, blood clots, carpal tunnel, etc.), but you may still benefit from the procedures involved in warming hands and feet.
Galvanic Skin Response (GSR) or Skin Conductance Activity:
The skin contains multiple sweat glands which respond to such emotions as fear and anxiety by excreting sweat, which directly increases conductance of electrical impulses to the outer surfaces of the skin. Like water, sweat also conducts electricity, but has less is less resistance to electricity as conductive salts are also excreted with sweat. Thus, sweaty skin is less resistant to electricity than dry skin. GSR biofeedback measures the amount of electrical impulses on the surface skin of two fingers, the direct result of increased sweat gland activity. GSR biofeedback is well known as a direct measure of anxiety. For example, an individual may associate anxiety with “sweaty palms or clammy hands,” “breaking out in a cold sweat,” or “sweating bullets.” In contrast, a perception of reduced anxiety would yield the phrase, “No sweat.” An example of a GSR response under anxiety would be sweaty palms at a job interview, or anticipation anxiety.
Blood Pressure (BP):
For those concerned about rising blood pressure under stress, or as a result of “essential hypertension,” we utilize blood pressure monitoring through the computer biofeedback as well as with a free-standing blood pressure monitor unit. The goal is to learn skills to attempt to lower blood pressure, and then take readings in-between rounds to see if it is possible to lower the systolic top number measure (squeezing of the heart to pump blood), and the diastolic bottom number measure (relaxation of the heart to fill with blood). This may be more effective when blood pressure rises as a result of factors not directly influenced by any medical conditions. Stress, tense breathing patterns and tightness in torso, “white coat hypertension” (worrying about high BP leads to rising BP), and time factors and tensions causing rising BP may be of influence for some individuals.
For many individuals, heart rate tends to increase with anxiety. Through measuring precise heart rate, and providing spectral analysis, we can train heart rate variability. Through heart rate biofeedback, we can measure the amount of sympathetic, parasympathetic and combined activity that influences a client’s heart rate. Through proper breathing and relaxation training, clients can observe how to calm themselves, reduce heart rate, and learn how to reduce symptoms of anxiety and panic, as well as other psychosomatic symptoms.
To achieve proper breathing, we should breathe diaphragmatically, in a slow, deep, even and continuous manner. By breathing properly throughout the day, we may achieve a relaxed mind and body and maintain a state of good health and balance. Too often, we breathe improperly through chest breathing, uneven breathing, anxious hyperventilation, shallow breathing, or depressed and labored breathing (the deep sigh). Improper breathing can lead to increased anxiety and autonomic activity, increased muscle tension, and a tense and overactive bodily system. Biofeedback monitors breathing patterns through the use of a dual string-gage with placements on both the chest and abdomen. Through coaching, improper breathing can be monitored and correct breathing can be learned and practiced.
Biofeedback measures changes that are often subtle, sometimes too subtle to be brought to awareness without biofeedback, or without great deal of training in self-awareness skills. For example, a GSR response can occur in small amounts, such that the palms don’t feel sweaty. Slight muscle tension can occur without any obvious symptoms.
Peripheral temperature can change without one’s awareness, until the hands and feet begin to feel increasingly cold. How often are we aware of improper breathing and irregular heart rate throughout the busy day? On the other hand, such changes can be extreme, leading to the familiar and intense feelings of anxiety that are often associated with experiences of unpleasantness. Biofeedback allows for observation of all changes, from the very subtle to the extreme, with the objective of enhancing self-awareness skills to be transferable to the world outside of the clinical office.
A client can become increasingly knowledgeable of the biofeedback process throughout each session, and learn to become his or her own therapist. The first step is the hooking-up procedures, which involve applying rubbing alcohol for cleaning the surface of the skin and eliminating dirt and material that can interfere with signals being measured. Sensors are wires with mechanical receptors which are placed on the skin to receive electrical impulses and thermal temperature emissions, and receive direct feedback related to a stress response. The sights of placement include several fingers, the wrists, and various locations on the body where EMG feedback is effective (forehead, trapezius muscle of the neck, etc.). When connections are made, it is important for the client to remain still, as movement can interfere with signals and prevent accurate feedback.
Biofeedback data can be received in both visual and audio form, and provide moment-to-moment feedback on display demonstrating how rapidly physiology changes in response to thought and behavior. At the end of the session, the therapist can generate a report of the entire procedure to demonstrate how changes occurred throughout the session. What occurs on the screen in the therapist’s office represents a snapshot of the reactivity of a client’s physiological system, which may be an ongoing typical pattern. Audio feedback offers different choices of sounds and pitches, which can be set to increase or decrease relative to the level and type of physiological activity occurring and being monitored.
Some common biofeedback indicators of unhealthy stress patterns may include rapid changes of physiological data on the screen in response to stress, diminished ability to recover from a stress response, multiple dominant modes involved in response to stress, and chronic negative thoughts and images that increase a stress response. A lack of response may demonstrate the possibility of defensiveness and detachment from the therapeutic process, a desire to over- control the therapeutic situation, or feeling helpless.
The biofeedback system offers a threshold, which serves as a client’s baseline reference point on each biofeedback modality. All positive and negative physiological changes in the session can be compared against the initial threshold to monitor a client’s level of progress or lack of progress in reducing stress-related bodily functions during the session. As a client improves in reducing the stress response beyond threshold, the therapist may alter the level of threshold to increase the challenge and help the client further improve skills. The key is to learn how to recover and return to baseline rapidly. After all, it is often not stress that harms, but lack of recovery from stress.
Some important points may help you be more effective in your biofeedback treatment program. First, always relax your jaw when it is not in use. A tense jaw is very commonly a contributor to disorders of muscle tension in areas of the head, face and neck. The jaw also begins the digestive track, and is intimately connected with digestive and elimination functions. Be aware of your breathing, and understand its role in mental and bodily stress. Breathing is often the most critical part of a successful biofeedback program. Also, if you can make a symptom worse in biofeedback, you can also make it better. The key is to understand how you make your body change. Become aware of exactly how you feel and what you do specifically that results in significant increases or decreases in biofeedback. Become attuned to your ideal mental / physiological state. In your daily life, try to transfer your awareness to your lifestyle, daily habits and experiences. Also, try to imagine your whole body healing rather than just the presenting problem.
With biofeedback, trying too hard seldom works. The principles of stress management are based on yielding, which is passively letting go and allowing your body to heal as it knows best, without mental pressure. Therefore, allow yourself the opportunity to learn your body’s secrets for letting go and healing. Don’t focus on the issue, just go into biofeedback with an image of your healing response and relaxed self.
Take mini opportunities to master and benefit from stress management tools throughout the day (e.g., while food is cooking in microwave, while waiting in line at bank, etc.). Check your posture to make sure your sitting or standing tall but relaxed, check breathing, and so on. Fit stress management comfortably in your life. Affirm your success every time you succeed in calming your mind and body. Build small reminders throughout the day to practice your stress management strategies.
The most important factor in biofeedback training is to generalize self-awareness and stress-reduction skills out of the office and in daily life. The goal is to develop self-awareness of internal cues about all the ways your body reacts, and to be aware of your thinking and breathing. Then you know what to target, and how to alleviate that response effectively. The ultimate goal is to learn how to reduce stress, anywhere, anytime. Consider a biofeedback stress management program as serious training for making important changes toward better health and self-mastery. You may be asked by your therapist (coach) to examine lifestyle behaviors, and seek more health promoting behaviors. Other factors that may affect your ability to relax during biofeedback include caffeine, tobacco, alcohol, high sugared foods, allergies, medication, history of seizures and/or cognitive deficits, and drug withdrawal. The more you put into the program, the better your therapist (coach) can help you achieve goals. The ultimate goal is to help you get well. You may learn many new skills that are highly beneficial for achieving relaxation & short-circuiting stress, but your motivation is the key to success.
Dr. Ben Allen is certified in biofeedback and provides state-of-the-art biofeedback equipment and strategies based on each training modality.